VT Health Care Innovation Project

Health Information Exchange Work Group Meeting Minutes

Pending Work Group Approval Date of meeting: Wednesday, December 17, 2014; 10:00am-12:30pm, DVHA 312 Hurricane Lane, Large Conference Room, Williston

Agenda Item

Discussion Next Steps

1. Welcome and Introductions

Brian Otley called the meeting to order at 10:05am. A roll call attendance was taken and a quorum was present.

2. Review and Acceptance of November 19th Meeting Minutes

Nancy Marinelli requested small edits to page two of the November 19th minutes. Heather Skeels moved to approve the November minutes by exception, Nancy Marinelli seconded. There were no stated exceptions and the minutes were approved.

3. Detailed update on ACTT Projects

Larry Sandage provided an update on ACTT Project 1 (VCN Data Quality, Data Repository, and SSA EHR Project.) Elise Ames provided updates on Projects 2 (LTSS Data Planning) and 3 (Universal Transfer Protocol/UTP). Larry and Elise responded to Work Group member questions on both projects: Project 2:

• Paul Harrington asked: Did contractors speak with any adult day centers or other providers? Elise Ames responded that her team met with the HIT Directors of the home health agencies and is setting up interviews with VNA leadership to gather input.

• Technology assessments will be completed through scripted interviews with providers, as well as a few software vendors. Elise Ames reported being impressed by recent progress and future plans to introduce HIT in LTSS settings. This is a six month-long project – the next phase is to make a plan to integrate these providers into VHIE and other HIE tools.

• Paul Harrington asked: How does this fit into payment reform? Elise Ames responded that she is looking at existing measures of LTSS now; the concept is that measures are needed for payment and also for performance measurement. There’s a discussion on what’s currently being collected by agencies and what would be important – both claims and non-claims-based measures (i.e., fall risk).

Work Group staff will follow up with Amy Putnam.

1

Agenda Item

Discussion Next Steps

Project 3: • Paul Harrington asked: How are “providers” defined? Elise Ames responded that the definition of

providers could include traumatic brain injury providers, as well as hospitals, in-patient long-term care providers, and others regularly involved in care transfers; this also includes acute providers.

• Richard Slusky asked: Is this integrated with CMCM Work Group? Georgia Maheras responded that yes, there was purposeful overlap, especially in the St. Johnsbury area since it overlaps with the learning collaborative service area. There is a focus on avoiding duplication of effort and capitalizing on current efforts. In addition, the project is considering moving into a third community, and will do more provider interviews as needed to ensure sufficient depth.

• Amy Putnam asked: With the UTP and transitions of care, is the methodology of care coordination around referrals part of the discussion? Elise Ames responded that referrals are one of the use cases. Georgia Maheras added that staff will follow up on this issue.

• Sean Uiterwyk asked: Are pharmacies included in UTP? Clinically, different care settings often have different medication lists, and patients may receive multiple medication lists from different providers or settings while pharmacies have automatic refills based on previous medication lists or prescriptions. How can we involve the pharmacies to ensure automatic refills or prescriptions are reconciled? Elise Ames responded that her team has discussed this issue with providers and will be meeting with pharmacies that regularly interact with LTC facilities; however, they are not currently included in UTP interviews. Paul Harrington added that as VITL Access develops the HIE, medication lists are one of the data elements that will be available, drawn from the large national PBMs rather than individual providers – this should act as a good aggregator. Larry Sandage added that the scope of this project has narrowed from initial plans to create the initial recommendation; Phases 2 and 3 of this project will build on that. Steve Maier added that VITL Access will also allow providers access to a complete list of medications that have been filled.

4. Review of Year 1 Accomplishments and Year 2 Milestones

Year 1 Accomplishments: Larry Sandage reported on Year 1 successes (“winformation!” – Nancy Marinelli). • ACO Population Health proposal • ACTT Partners proposal • Stone Data Inventory Project approved • Telehealth Project negotiations launched

Brian Otley requested feedback from Work Group members on successes and value of work group process.

• Paul Harrington reported that he believes this group has been productive and is using funds well with in-state contractors to promote use and usefulness of HIT in Vermont.

• Nancy Marinelli commented that this group has stayed focused and has recommended/approved/selected projects that will support good outcomes.

• Larry Sandage stated that he thinks this work has been very supportive of HIE goals and supported VITL in moving toward connection with broader provider types, both through funding and effort.

2

Agenda Item

Discussion Next Steps

Year 2 Milestones: Larry Sandage described major Year 2 milestones, including the Event Notification System Project, the Stone Data Inventory Project, and the ACO Gateways. Resources are limited for new projects in Year 2 – the majority of funds have been expended in projects already approved for Years 1-3. The HIE/HIT Work Group Leadership Team has prioritized building something tangible; taking advantage of best practices and innovations within the broader market in the state, nationally, and globally; and building a sustainable system.

• Larry provided additional information provided on the Stone Data Inventory Project, requested by Lou McLaren.

• Paul Harrington suggested adding language around health information technology and exchange to this list of goals to ensure clarity for stakeholders outside this work group.

Larry Sandage described proposed goals for Year 2:

• Data quality: Research and potentially pilot innovative methods other communities have used to improve data quality throughout the HIE process.

• Interoperability: Research methods and technologies for improved extraction of data elements; and create business and policy recommendations in support of privacy and security.

o Lou McLaren suggested that payers could be good sources of information for this research, especially Blue Cross and Cigna, who can leverage national networks. Nancy Marinelli concurred and emphasized usability for consumers and others end users, as well as sustainability concerns. Larry Sandage agreed, and tied this to privacy and security concerns.

o Ken Gingras added that there has been a shift in how these technologies are paid for – rather than major up-front costs, many products are subscription services where up-front costs are low and on-going costs are higher.

o Sean Uiterwyk commented that as data exchange increases, data use agreements become very important, but there are many of them, they are all long, the language is opaque, and the process for approval is cumbersome. Could common standards ease this process so DUAs don’t need to be renegotiated each time?

• Clinical Data Governance: Research and possibly pilot innovating methods other communities have used to improve data quality throughout the HIE process.

o Nancy Marinelli supports this goal. Larry Sandage distinguished data governance at the policy level with the technology level – identity matching, proper consent, etc.

o Kaili Kuiper asked: How does this overlap with VHCURES data governance? Georgia Maheras responded that data governance is important across the board, not just with clinical data. Alignment across data types is important; this is about clinical data, but we’ll be coordinating with Green Mountain Care Board to ensure alignment with VHCURES.

o Richard Slusky asked: Who is the “governor” of data governance? Georgia Maheras responded that this isn’t one individual; it isn’t only government or only private sector. It needs to involve

3

Agenda Item

Discussion Next Steps

people who use and produce data and be cross-cutting to make sure decisions are well-informed and key stakeholders are involved. There are multiple authorities, some overlapping, to different entities. We are working to provide clarity around where overlapping authorities are and supporting coordination between different agencies/oversight bodies. Paul Harrington added that the VHITP can be a proxy for that single voice; a single

governance structure might not be desirable. Alignment across governance entities/structures will be critical.

Steve Maier commented that roles and responsibilities among different governance structures need to be very clear – well defined and communicated across different entities and stakeholders.

Eileen Underwood added that this will impact timeline for other projects. Amy Putnam commented that providers need guidance on this as well – lack of

confidence in knowing what data governance and liability are is holding providers back. Paul Harrington state that he believes the state needs to take the lead on establishing

governance structures. • Sustainability: Continued support of the VHITP development. How will this be sustained over the next 5-

10-20 years? • Structure to Support Utility: Continued support and development toward a “data utility” to support

State data needs. This is building a data utility for clinical and mental health data. What is the structure moving forward? The work group and stakeholders will need to have unified thinking on this.

o Lou McLaren asked: Who pays for the utility, if we’re all paying for it? Also, to the extent that these projects have ongoing costs, who pays for that? Larry Sandage replied that the leadership team and the State are working on sustainability models now. Ken Gingras added that as the Triple Aim bends the cost curve, it will produce savings – could we track savings produced by these projects and reattribute these savings to these projects to fund sustainability?

o Paul Harrington commented that sustainability is a mechanism, not a goal in itself. These proposed goals will be the high-level workplan goals for Year 2, if approved. Each one is linked to initial workplan goals from Year 1. The Leadership Team requests any feedback within the next week.

5. Update on Stone Proposal and Telehealth Proposal

Georgia Maheras provided a brief update on the Stone proposal. Sarah Kinsler, a new staff member on the VHCIP team, will manage the Stone contract; additional information will be provided in January and February 2015. A first step will be asking this group for feedback on potential data sources to inventory. The State is currently in talks with a bidder for the telehealth contract and will have more to report in the New Year.

New Item: New Project-Wide

Georgia Maheras described the new project-wide attendance policy for Work Group members to ensure Work Groups can achieve a quorum and make decisions. The policy will be shared via email.

4

Agenda Item

Discussion Next Steps

Attendance Policy • As in the past, members may select member alternates. • Members must attend at least 50% of meetings throughout the year, and may not miss 3 consecutive

meetings without good reason; if members do not meet this standard, they will be moved to the interested parties list.

Group members requested meeting schedules further in advance.

6. Public Comment There was no public comment. 7. Next Steps, Wrap Up and Future Meeting Schedule

Next Meeting: Wednesday, January 21, 2015; 1:00-3:00pm, DVHA 312 Hurricane Lane, Large Conference Room, Williston.

5